Daily Activities Of Patients Research Articles

Duration and frequency of every day activities in total hip patients

Little knowledge about frequency and duration of daily activities in patients after total hip arthroplasty is available. Such information is required for the definition of realistic load collectives for pre-clinical testing of prostheses. It could also be helpful for the quantitative evaluation of surgery outcome with different prosthesis types. The purpose of this study was to develop and apply a system for the determination of frequency and duration of patient activities in their habitual environment and to compare the results to a clinical outcome score (Harris hip score). A portable activity monitoring system (weight 1.6 kg including batteries) was designed using a Palmtop computer, 2 inclination sensors for the thigh and calf and one goniometer positioned at the knee joint. An algorithm was developed to identify frequency and duration of the activities lying, sitting, standing, walking and stair climbing from the signals of the 3 sensors. 42 patients participated in the study and were equipped with the system in the morning at their home. Datasets of 31 patients (age 62.5±11.5 y) covered more than 6 h (9.8±1.6 h) and were included in the analysis. Prosthesis specific data as well as the Harris hip score were collected. The most frequent patient activity was sitting (44.3% of the time), followed by standing (24.5%), walking (10.2%), lying (5.8%) and stair climbing (0.4%). The median number of steps/stairs was 6048/164. The number of step cycles representing one year in vivo use should, consequently, be increaesed to 1.1 million. The Harris hip score (91.4±9.8) correlated significantly with the number of stairs ( r 2=0.26, p=0.003) and showed a positive tendency with the number of steps per day. No differences in activity levels between prosthesis specific factors were found.

THE CUMULATIVE EFFECT OF LONG-ACTING BRONCHODILATORS, EXERCISE, AND INSPIRATORY MUSCLE TRAINING ON THE PERCEPTION OF DYSPNEA IN PATIENTS WITH ADVANCED COPD

Weiner, P; Magadle, R; Berar-Yanay, N; Davidovich, A; Weiner, MEditor(s): Cannistra, Lauralyn MD; Carlin, Brian MD; Keteyian, Steven J. PhD

Thoracoscopic splanchnicectomy for control of intractable pain due to advanced pancreatic cancer.

Severe upper abdominal pain is a dominant and distressing feature of advanced pancreatic cancer. This study was performed to evaluate pain intensity and to determine the ways in which pain may interfere with the common daily activities of patients with intractable pain before and after thoracoscopic splanchnicectomy. Twenty-six left-sided thoracoscopic splanchnicectomies were performed. To assess pain severity and the impact of pain, all patients completed a short questionnaire using the 0-10 Numeric Rating Scale. The Pain Management Index was used to describe and compare the adequacy of analgesic management. Patients were evaluated 1 day prior to operation and for 6 months after the procedure. Pain was reduced significantly after the operation (p < 0.001), and all patients enjoyed consistent pain relief during the postoperative follow-up. The degree to which pain interfered with their daily function decreased significantly (p < 0.001) after surgery. The adequacy of the analgesic management improved, and none of the patients required opioids. Unilateral left thoracoscopic splanchnicectomy is a simple, minimally invasive, effective, and safe procedure that can be recommended as the method of choice for the management of intractable upper abdominal pain due to advanced pancreatic cancer.

The Pick-up Test for Assessing Performance of a Daily Activity in Patients with Back Pain

The Pick-up Test for Assessing Performance of a Daily Activity in Patients with Back Pain

Double blinded evaluation of the effects of pallidal and subthalamic nucleus stimulation on daytime activity in advanced Parkinson's disease.

The results of a double blinded evaluation of the effects of globus pallidus (GPi; n=7) and subthalamic nucleus (STN; n=11) stimulation in patients with advanced Parkinson's disease are summarized. The patients were evaluated at 6-8months after surgery. In order to determine the benefits afforded by the stimulation to the actual daily activities, the patients were maintained on-medication with optimal doses and schedules. The stimulation was turned off overnight for at least 12h. It was turned on in the morning (or maintained turned off), and the best and worst scores during daytime activity were recorded, as on-period and off-period scores, respectively. A reduction in total motor score on the Unified Parkinson's Disease Rating Scale was clearly elicited by GPi and STN stimulation at both the off-period (-57 and -29%, respectively) and the on-period (-36 and -25%, respectively). The difference in effects between GPi and STN stimulation appeared to be due largely to an unintended difference in the patients' preoperative symptoms. The benefits provided by stimulation to the actual daily activities appears to be limited in patients who have become unresponsive to a large dose of levodopa. Two advantages of GPi and STN stimulation were identified. Firstly, the stimulation can supplement a reduced action of levodopa during the off-period. It thus improves the patient's daily activities through attenuation of the motor fluctuations. Secondly, the stimulation can replace part of the action of levodopa during the on-period. It thus attenuates dopa-induced dyskinesia through a reduced dose of medication. More importantly, the stimulation improves the daily activities in dopa-intolerant patients who are being administered a small dose of levodopa because of unbearable side effects. In addition, GPi stimulation has its own inhibitory effect on dopa-induced dyskinesia. Clinically important improvement was observed in severe gait freezing in 2 patients following unilateral anterodorsal GPi stimulation on the right side alone.

The Cumulative Effect of Long-Acting Bronchodilators, Exercise, and Inspiratory Muscle Training on the Perception of Dyspnea in Patients With Advanced COPD

Dyspnea is a common complaint during daily activities in patients with advanced COPD. The mechanisms underlying dyspnea and the appropriate treatment strategies to relieve it are still not totally understood. We hypothesized that the perception of dyspnea (POD) may be modified by the accumulative effect of bronchodilator therapy, exercise, and inspiratory muscle training (IMT). Spirometry, submaximal exercise performance, inspiratory muscle strength and endurance, and the POD were assessed before and following three consecutive 6-week periods of therapy with a long-acting bronchodilator (LABD), the LABD plus exercise, and the LABD plus exercise plus IMT in 30 patients with moderate-to-severe COPD. There was a small, statistically insignificant, increase in FEV(1) in the study group (mean [+/- SEM] increase, 1.42+/-0.3 to 1.49+/-0.4 L) following the LABD therapy period, and no additional increase following the two other periods of therapy. There was a significant increase (p<0.05) in the 6-min walk distance following the therapy period with the LABD plus exercise (mean increase, 252+/-41 to 294+/-47 m) and an additional small increase following the therapy period with the LABD plus exercise plus IMT period (mean increase, 252+/-41 to 302+/-49 m). The decrease in the POD was small and statistically not significant following the therapy periods with the LABD and the LABD plus exercise. The major and statistically significant decrease in the POD was noted following the therapy period with the LABD plus exercise plus IMT. In patients with moderate-to-severe COPD, following sequential periods of therapy with the LABD, the LABD plus exercise, and the LABD plus exercise plus IMT, there is a cumulative benefit in the POD. The most significant improvement was associated with IMT and not with the LABD and exercise training. The FEV(1) was moderately increased following the therapy period with the LABD, and the addition of exercise has most affected the 6-min walk distance.

Effect of 60 mg twice-daily fexofenadine HCl on quality of life, work and classroom productivity, and regular activity in patients with chronic idiopathic urticaria

The effect of 60 mg twice-daily fexofenadine HCl on health-related quality of life and productivity at work, in the classroom, and during daily activities in patients with moderate to severe chronic idiopathic urticaria symptoms was studied in two identical, 4-week, placebo-controlled, multicenter clinical trials. Patients self-administered the Dermatology Life Quality Index (score, 0-30) and the Work Productivity and Activity Impairment instrument (0%-100%). In both trials, improvements in Dermatology Life Quality Index scores in fexofenadine-treated patients (N = 169) were statistically significant compared with placebo (P ≤.0002). Similarly, improvements in productivity scores with fexofenadine 60 mg twice daily were statistically superior to placebo at work (n = 120, P ≤.0152) and in performance of daily activities (n = 166, P ≤.0002). There was a trend toward improved classroom productivity (n = 26) with fexofenadine. We conclude fexofenadine 60 mg twice daily improves health-related quality of life, increases work productivity, and improves performance of daily activities in patients with moderate to severe chronic idiopathic urticaria. (J Am Acad Dermatol 2000;43:24-30.)

Fexofenadine HCl is safe and effective for treatment of chronic idiopathic urticaria

Fexofenadine is a nonsedating antihistamine approved for treatment of seasonal allergic rhinitis. This dose-finding study assessed the safety and efficacy of fexofenadine in chronic idiopathic urticaria. The 4-week, double-blind, randomized, placebo-controlled study included patients diagnosed with chronic urticaria who had moderate to severe pruritus. Patients received twice daily oral doses of placebo or fexofenadine HCl (20, 60, 120, or 240 mg) at 7 AM and 7 PM. Patients recorded scores for pruritus severity and number of wheals (over the previous 12 hours) in a daily diary. Efficacy variables included mean daily changes from baseline in pruritus severity, number of wheals, and interference with sleep and daily activities due to urticaria. Patients (N = 418) from 37 investigative sites were included. All four fexofenadine HCl doses were statistically superior to placebo (P < or = .0115) for reducing pruritus and number of wheals scores over the 4-week treatment period. There were greater reductions in urticaria symptoms in the 60 mg fexofenadine HCl group than in the 20 mg group, while similar reductions were observed in the 60, 120, and 240 mg dose groups. Additionally, patients receiving fexofenadine experienced significantly less interference with sleep and daily activities than patients receiving placebo (P < or = .0014). Adverse events occurred with similar incidence in all treatment groups, with no dose-related increases in any event. Fexofenadine HCl significantly reduced pruritus severity, number of wheals, and interference with sleep and normal daily activities in patients with chronic urticaria compared with placebo. Twice-daily doses of 60 mg or greater were most effective.

Pressure support and elevation following the removal of a radial artery for coronary artery bypass grafting

The saphenous vein was once the standard coronary artery bypass graft. Alternate grafts, primarily the radial artery and the internal mammary artery are now being utilised for revascularisation of the heart. However, the radial artery graft site can be at risk of oedema and the development of haematoma during the post-operative period. Also tension on the suture line may compromise circulation and create functional problems for the patient. The aim of this study was to assess the effect of pressure support (elastic support bandage) and elevation in reducing swelling and arm discomfort in the harvest arm. The patients in the study undergoing coronary artery bypass grafts were randomly assigned to one of three groups: elastic support bandage, collar and cuff sling and elevation on two pillows. There were 30 patients in each group. The circumference at three locations on the forearm was measured pre-operatively and on post-operative days 3 and 5. Pain was measured on a visual pain scale, which went from 1-10, with 10 being the most painful. The patients were also asked whether their arm movement felt restricted. The study found that there was no statistically significant difference (at the 0.05 level) between the three groups in the amount of swelling witnessed at the different forearm locations. There was, however, a significant decrease in swelling for all groups between days 3-5, but no difference in pain scores between the groups. Moreover, the collar and cuff sling group reported movement restriction, which was not apparent in the other two groups. In view of the findings, the researchers advocate the elastic support bandage. Patient compliance has practical implications when applying treatment and this is enhanced by the non cumbersome elastic support bandage. This can be compared to the collar and cuff sling and pillow elevation groups where the patient's daily activities affects compliance with these two treatments. It is recommended that future research be conducted comparing the effects of the elastic support bandage with a control group.

The Health Hero?? Online Service

This article describes recent developments in remote patient self-management programmes for care management. An overview of current practices in disease management, care management and quality improvement is provided along with descriptions of enabling technologies including interactive voice response (IVR) and new patient communication and data capture systems. A new technology platform for disease management, case management and performance measurement ‘the Health Hero® online service — is presented and described. The Health Hero® platform features a patient information appliance (the Health Hero® Health Buddy® appliance), a central data centre, and an Internet-based service facilitating the daily activities of patient- and population-based care management, disease management and performance measurement. Results from preliminary field testing of the Health Hero® online service are presented. These results indicate that compliance (usage) with the Health Hero® online service is consistently above 90% and that patient satisfaction is high. Surveys conducted on the Health Hero® online service indicate the device is easy to set-up and use, and that the likelihood of patients’ continuing to use the Health Hero® online service is high and increases with time (from 80 to 93% over 3 months). Remote patient care management systems, such as the Health Hero® Internet-based communications platform and some IVR systems, facilitate efficient monitoring of patients. They consequently provide a foundation for better outcomes and quality of life for patients and reductions in the cost of healthcare delivery.

Utility of an Accelerometer Sensor Integrated into a Holter Monitoring System

Background:Patients routinely undergo Holter monitor evaluation for the detection of cardiac arrhythmias. Documentation of daily patient activities is a common shortcoming. Discriminating physiological from pathological heart rate, e.g., sinus tachycardia in response to exercise from supraventricular tachyarrhythmia, can be difficult without an accurate diary. Independent documentation of body activity may help solve this inadequacy. Accelerometer-based pacing systems have established the utility of general body activity detection for pacemaker rate determination. Methods:An accelerometer sensor was positioned in the left pectoral region in 10 volunteers for measurement of normal daily subject activity. Additionally, the volunteers were asked to keep a detailed diary of daily activities. The accelerometer sensor signal was recorded on one channel of a modified Holter monitor system. The Holter FCG and accelerometer data were analyzed and compared to the detailed diary. The study was then repeated in 10 patients undergoing standard Holter monitor evaluation. Results:In all 20 subjects, reviewing the 24-hour profiles allowed correlation of heart rate response to activities such as walking, resting, exercise, or sleep and the accelerometer sensor signal. In the patients, a total of 170 minutes of increased heart rate correlated with documented physical activity, while 14 minutes did not. Additionally, 161 minutes of bradycardia during physical activity were also identified. Conclusion:Present-day Holter systems can detect bradycardias and tachycardias based on ECG characteristics and rate criteria. The addition of acceterometer signal to standard Holter ECG might improve physician interpretation of patient heart rate response to daily patient activities. A.N.E. 2000;5(1):73–78

Discrepancy between subjective and objective ratings for negative symptoms

A better knowledge of the schizophrenic patients' awareness of negative symptoms may lead to a more empathic approach of these patients, especially within the context of rehabilitation programs. In order to examine the awareness of these symptoms, we have developed a self-rating scale, the Subjective Experience of Negative Symptoms scale (SENS; Selten et al., 1993). Since the items of this scale were taken from the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1989), the patient's rating can be compared to the psychiatrist's rating for the corresponding SANS item. Evidence for validity of the SENS was provided by a study that compared schizophrenic patients to patients with a depressive disorder and to normal subjects. Since the schizophrenic patients were found to report more impairments than the normal subjects did, it was inferred that they are at least `somewhat' aware of their negative symptoms. On the other hand, as they reported fewer impairments than did the patients with a depressive disorder, the results implied that the schizophrenic patients are less aware of their impairments than are patients with a depressive disorder (Selten et al., 1998). The aim of this letter is to describe the proportions of schizophrenic patients who participated in the above study and failed to report negative symptoms that were assessed as present by a psychiatrist. The patients (DSM-III-R criteria; 60 men and 26 women) were recruited from the mediumand long-stay wards of two mental hospitals. Patients who had a physical handicap that explained their impaired functioning were excluded. Other reasons for exclusion were the presence of mental subnormality (de®ned as the failure to complete primary education or having repeated more than one class at primary school), an organic mental disorder (DSM-III-R), recent or current substance abuse (DSM-III-R) and a current manic or major depressive episode (DSM-IIIR). Their mean age was 44.4 years (range 20±65). The length of admission varied greatly: less than a year in 26 patients and more than 5 years in 35 patients (median: 44.5 months). In one session the patient assessed himself with help of an interviewer. The interviewer gave a standardized explanation of the item in everyday language and asked a prescribed question, for instance: ``How much energy do you have?'' Next, he handed the patient a card that listed ®ve alternative answers: ``very little'' (1), ``little'' (2), ``average'' (3), ``a lot'' (4) and ``very much'' (5). Thus, the patient could indicate the presence of the symptom with a rating of ``1'' or ``2''. The patient was instructed to compare himself to other people of his age outside the hospital and had to choose one answer. In another session a psychiatrist (J.P.S.) assessed the patient using the SANS. His interrater reliability was sucient (ICC for SANS summary score: 0.81). The interval between both sessions was limited to a maximum of one week. In order to provide the psychiatrist with detailed information about the patient's daily activities, nurses completed the REHAB, a scale for the assessment of psychiatric disability which shows large overlap with negative symptom rating scales (Baker and Hall, 1988). The psychiatrist and the patient were blind to each other's ratings. After 2 months the measurements were repeated in 80 patients. SANS ratings of at least `2' (``mild, but de®nite'') were taken as scores indicating the presence of the symptom. Journal of Psychiatric Research 34 (2000) 11±13

Initial results of treatment with the new AO wrist joint arthrodesis plate

Although diagnosis and therapeutic options for post-traumatic, idiopathic, and degenerative wrist arthropathies have improved during recent years, total wrist fusion is still frequently regarded as a popular option of treatment. Fourty-one patients underwent wrist arthrodesis between May 1994 and April 1996 using the recently introduced new AO-plate after earlier wrist trauma or Kienböck's disease. Thirty-five patients were examined. The average follow-up time was 15 months. Hand function and active digital range of motion (ADROM) was assessed clinically, grip strength was measured using a Jamar-Dynamometer and the Dexter-Computer-System. Patient's daily activities and general postoperative quality of life were estimated with the new DASH-questionnaire. It can be concluded from our data, that the widely claimed complete pain relief after total wrist fusion does not match reality. Eighty percent of the patients complained about reduction of postoperative quality of life with impaired personal hygiene and functional deficits; however, the majority would undergo the procedure again. Seventy percent of the patients returned to their original occupation. The DASH-questionnaire proved to be a very useful and sensitive tool for evaluating the patient's problems at the upper extremity.

Étude de l'effet antalgique et fonctionnel du port d'une orthèse lombaire souple dans la lombalgie aiguë

Introduction To study the effect of a lumbar belt on pain intensity and daily activities in patients with low back pain. Method Multi-center, randomised study comparing a group treated with a lumbar belt and a control group. Thirty-six subjects, men and women, with a mean age of 38.35 0.2 years suffering from low back pain and examined for the first time. Pain intensity, the clinical examination and the functional performances are evaluated after 8 and 21 days of treatment. Results The results show a good effect of the lumbar belt on pain intensity at 8 and 21 days, a partial effect on clinical parameters and functional performances. Conclusion These results, in spite of a small sample of population, contribute to determine the efficacy of lumbar belt in the treatment of low back pain, but also show the need for further studies, particularly on their long-term preventive effects in the workplace.

Effects of severity of long-standing congestive heart failure on pulmonary function

To investigate the effects of severity of long-standing congestive heart failure (CHF) on pulmonary function, we studied 53 (47 men) consecutive patients, all heart transplant candidates. Their mean (± sd) age and ejection fraction were 47 ± 12 years and 23 ± 7%, respectively. All patients underwent spirometry, lung volume, diffusion capacity ( D lCO), maximum inspiratory ( P imax) and expiratory pressure ( P emax) measurement. Maximum cardiopulmonary exercise test on a treadmill was also performed to determine maximum oxygen consumption ( V ̇ O 2max ). On the basis of V ̇ O 2max , the patients were then divided into those with a V ̇ O 2max > 14 ml min −1 kg −1 (group 1, n=30) and those with a V ̇ O 2max ≤ 14 ml min −1 kg −1 (group 2, n=23). In comparison with group 1, group 2 patients had lower FEV 1 FVC (70 ± 8% vs 75 ± 7%, P=0·008), lower FEF 25–75 (46 ± 21 vs 70 ± 26%pred, P<0·001), lower TLC (76 ± 15 vs 85 ± 13%pred, P=0·02) and lower P imax (68 ± 20 vs 87 ± 22 cmH 2O, P=0·003), but comparable D lCO (84 ± 15 vs 88 ± 20%pred, P=N.S.), and P emax (99 ± 25 vs 96 ± 22 cmH 2O, P=N.S.). In conclusion, our data suggest that respiratory abnormalities, such as restrictive defects, airway obstruction, and inspiratory muscle weakness, are more pronounced in patients with severe CHF than in those with mild-to-moderate disease. Further studies are required to investigate the extent to which these abnormalities contribute to dyspnoea during daily activities in patients with heart failure.

Lipophilic versus hydrophilic β1 blockers and the cardiac sympatho-vagal balance during stress and daily activity in patients after acute myocardial infarction

ObjectiveTo compare the effects of a lipophilic and a hydrophilic β1 blocker on cardiac sympatho-vagal balance during daytime activity and stress in patients four to six weeks after myocardial infarction.DesignRandomised,...

Retention dressings: a new option for donor site dressings.

Split skin graft donor site dressings should be cheap, easy to apply and remove, reduce pain, provide a moist wound healing environment, be easy to care for and cause minimal interference in the patient's daily activities. Adhesive retention dressings seem to provide these features and are a new option for donor site dressings.

Effect of Sustained-Release Verapamil on the Morning Systemic Arterial Pressure Surge During Daily Activity in Patients With Systemic Hypertension

In a placebo-controlled study of 13 subjects with systemic hypertension, sustained-release verapamil reduced the morning surge in systolic pressure by 10.2 mm Hg (p = 0.04), diastolic pressure by 11.1 mm Hg (p = 0.008), and heart rate by 3.3 beats/min (p = 0.17). Blunting of the morning hemodynamic surge may be a mechanism by which verapamil could reduce the risk of plaque disruption and acute coronary events in the morning.

The patient's daily activities in acute psychiatric care.

This study is part of a research project entitled: 'Towards patient-focused nursing on an acute psychiatric ward'. The aim of the project is to describe the changes taking place in nursing activities during a research project. This paper is a qualitative analysis of the patient's daily activities in acute psychiatric care. The data were collected by observing, selectively, seven patients for 61 h. The constant comparative method was used in data analysis. On the basis of the data analysis, the categories listed below were identified. 1 The core category of the patient's daily activities was 'being a patient'. 2 Being a patient mainly consisted of being alone without meaningful activities. 3 Participating in the daily routines of the ward consisted of being alone while being together with others. 4 Being together was initiated by either the patient or the nurse. The aim of being together was to satisfy the acute basic needs of the patients. 5 Being together on the initiative of the nurse meant participating in the daily routines of the ward. Because the data were collected by observation, no insight into the patients' desires, expectations and thoughts could be presented. The findings challenged the nursing staff to develop a more therapeutic daily routine in acute psychiatric care. It was also of importance to change the patients' meaningless existence into a meaningful participation in the daily activities on the ward.

Counselling guidelines for managing musculoskeletal problems in haemophilia in the 1990s.

Complex medical, psychological and social factors affect how patients with haemophilia and their families respond to bleeding episodes. Prompt, adequate treatment for bleeds remains the best way to preserve optimal musculoskeletal health. Untreated and under treated bleeding episodes into muscles and joints can cause pain, deformity and severely limit the daily activities of patients with haemophilia. Viral infections over the last decade have, to some extent, diverted attention away from musculoskeletal problems. The orthopaedic contribution to haemophilia care remains important and can be enhanced through regular review clinics and developing focused approaches to identifying and addressing musculoskeletal problems.